Endosonographic evaluation of pseudocyst pancreas: its impact on management
Kumar, M.; Sud, R.; Arora, A.; Puri, R. and Sama, SK (2002) Endosonographic evaluation of pseudocyst pancreas: its impact on management. Indian Journal of Gastroenterology, 21(Suppl 1) November. A86.
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Background: Endosonography (EUS) today is probably the best technique for evaluating the feasibility of endoscopic drainage of pseudocysts because of its accuracy in judging the cyst-gastrointestinal wall distance, intervening vessels and cyst contents. Objective: The aim of study was to evaluate the pseudocysts by EUS and plan further management Methods: 34 consecutive patients of pancreatic pseudocysts who presented to Gastroenterology Department between Jan 2001 to June 2002 were subjected to EUS using endosonoscope (Olympus GF-UM 130) under conscious sedation. Patients who satisfied the criteria of Cyst GI wall distance <lcm, relatively anechoic nature of cyst-contents and absence of vessels/collaterals in cyst GI wall were selected for endoscopic cystogastrostomy. Results: A total of 34 patients underwent EUS for assessment of pancreatic pseudocyst. There were 30 males and 4 females (Age 12 years to 62 years). These patients had undergone abdominal ultrasonography or CT scan of upper abdomen earlier as a diagnostic modality for diagnosis of pseudocyst 14/34 (41.2%) satisfied the criteria and underwent successful endoscopic cystogastrostomy without any complications. In 10/34 (29.4%) endoscopic cystogastrostomy was not feasible predominantly because of greater cyst GI wall thickness, in 3/34 (8.8%) because of collaterals/intervening vessels. In 7 (20.5%) cyst had solid debris/ suspected hemorrhage or thick contents precluding endoscopic cystic drainage. However of this last group 3 were subjected to endoscopic cystogastrostomy with dilatation of site and placement of 2 10F pigtail stents and of these one had significant infection and required surgery. All other patients underwent surgery. Conclusions: EUS is a useful modality of selecting proper patients suited for endoscopic drainage of pseudocyst
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